'She didn't get justice': Analysing barriers to post-rape medico-legal service provision in Kenya

Rockowitz, Sarah R. ORCID: 0000-0002-2759-8052 (2024). 'She didn't get justice': Analysing barriers to post-rape medico-legal service provision in Kenya. University of Birmingham. Ph.D.

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Abstract

Sexual and gender-based violence (SGBV) is a significant public health issue that affects millions of people around the world, especially women and girls. SGBV can have significant physical, mental, and social impacts, and victim/survivors rely on medico-legal professionals to provide medical care and pursue justice. Even though medico-legal services are essential for the wellbeing of victims, research indicates that service provision is lacking worldwide, but especially in East Africa, a region with higher-than-average rates of SGBV and significant resource constraints.
In this thesis I aim to explore the barriers faced both by rape survivors in accessing medico-legal services and medico-legal professionals in providing these services in urban and rural settings in Kenya. Further, I examine the lived experiences of my participants during the COVID-19 pandemic as well as during times of normalcy, while also situating the findings within a larger East-African context.
To begin my research and familiarise myself with medico-legal service provision in the East African context, I undertook a scoping literature review of 54 papers to synthesise the existing models of service provision in the region surrounding Kenya. I then conducted a prospective cross-sectional study on 541 case records held by the Wangu Kanja Foundation to evaluate patterns of violence in Kenya during the COVID-19 pandemic, research that was not in the original design of my PhD, but which emerged as a result of the ongoing worldwide pandemic. Following this study, I conducted a secondary data analysis on case records of 514 survivors engaged with the Wangu Kanja Foundation to evaluate patterns that might predict how far a victim moves through the case referral pathway in Kenya. Finally, I worked closely with my partner organisation to conduct my qualitative research.
The Wangu Kanja Foundation (WKF), which is based in Nairobi, Kenya, was a critical partner for this work, providing links to survivors on the ground, a library of data on previous violence in Kenya, and networking opportunities that were crucial when interviewing medico-legal service providers for this work. Due to the COVID-19 pandemic, I had to significantly postpone my fieldwork and the plan for this research was altered to accommodate travel restrictions. I conducted online interviews with medico-legal service providers between January and October 2021 with five medical professionals and six legal professionals. During this time, two in-person focus group discussions were also conducted by members of the WKF using interview guides I designed and based on an online training I conducted with Kenyan facilitators to ensure that the focus group discussions were moderated appropriately. One focus group discussion had eight participants, and the other had nine. In April 2022 I was able to travel to three cities in Kenya, where I conducted three focus group discussions with survivors with the help of UK and Kenyan-based researchers, and a further 10 semi-structured interviews with professionals, five medical and five legal. Each focus group I conducted in person had ten participants. In exploring the potential reasons behind the challenges encountered by both providers and survivors attempting to access medico-legal services, I identified shared barriers, including financial constraints, insufficient understanding of correct procedures, sociocultural prejudices, and ineffective implementation of policies and guidelines.
Results indicated that barriers to post-rape medico-legal service provision were prominent, and that there was a sense of resignation amongst survivors concerning how their cases would (or would not) move through the case referral pathway. In my scoping review (Chapter 2), I found a dearth of literature on sexual violence policies in East Africa and highlighted a disproportionate focus on Kenya compared to the other countries in the region. In a prospective cross-sectional study (Chapter 3), I identified new patterns of violence that emerged during COVID-19, which have implications for safeguarding in case of future humanitarian crises, including the need for plans to protect children when guardians are absent and schools are closed. My secondary data analysis (Chapter 4) revealed that certain case characteristics, such as the age of the survivor and the presence of forensic evidence, helped cases progress through each stage of the care-seeking process, yet ultimately very few cases advanced through to the sentencing phase. In the qualitative research presented in Chapters 5 and 6, I conducted an in-depth analysis of the lived experiences of survivors in accessing care, as well as the experiences of professionals in providing care. The research on providers appears before the research on survivors in this thesis to ensure that the survivors have the final say on this topic.
The findings revealed a consensus among both providers and survivors that financial barriers constitute the primary impediment, followed by the need for formal training for providers in caring for survivors. Notably, provider bias (i.e., disbelieving a victim’s rape story because of her physical appearance) remains a significant issue, despite the implementation of interventions in Kenya several years prior to the commencement of my research. My thesis findings have implications for future research, policy, and practice, and provide evidence for how the Kenyan government and international non-governmental organisations (NGOs) can better respond to the needs of both the victims and the practitioners delivering post-sexual violence medico-legal services.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):